Maternal Adaptations in pregnancy

Question 1

Enlargement from stretching and hypertrophy in uterus is most marked at which area?

Answer 1

Fundus

Question 2

Layers of the uterus

Answer 2

Outer hoodedlike layer
Middle layer of muscles
Inner sphincter-like fibers

Question 3

The uterus rotates to which direction? This is caused by the recrosigmoid on the left side of the pelvis

Answer 3

Rotates to the RIGHT (dextrorotation)

Question 4

accounts for “false labor”; irregular, unpredictable, sporadic contractions which rises in number in the last two weeks of gestation

Answer 4

Braxton-Hicks contractions

Question 5

Uteroplacental blood flow is mediated by which small molecule?

Answer 5

Nitric oxide (a potent vasodilator)

Question 6

VEGF and PIGF are attenuated in response to the excess of which hormone?

Answer 6

Soluble FMS-like tyrosine kinase 1 (sFlt-1)

Question 7

Normal pregnancy has vascular refractoriness to which blood pressure mediator?

Answer 7

Angiotensin II

Question 8

Increased vascularity and edema causes the cervix to turn to which color?

Answer 8

Bluish (Chadwick’s sign)

Question 9

This process involves lowering collagen and proteoglycan concentrations and raises water content (compared with nonpregnant cervix)

Answer 9

Cervical ripening

Question 10

Copious amounts of mucus rich in Ig and cytokines produced by endorcervical glands causes the formation of this structure. This is expelled at the onset of labor (bloody show)

Answer 10

Mucus plug

Question 11

Char. pattern of cervical mucus seen when it is spread and dried on glass slide; caused by progesterone causes poor crystallization

Answer 11

Beading

Question 12

Char. pattern of cervical mucus seen when amniotic fluid violates the cervical canal. It is caused by estrogen and salts leading to crystallization

Answer 12

Ferning

Question 13

Organ that produces hCG which maintains the corpus luteum

Answer 13

Placenta

Question 14

This ovarian structure produces the progesterone which maintains the endometrium. It functions maximally until 7 weeks of pregnancy.

Answer 14

Corpus luteum (CL)

Question 15

Loss of polarity, pleiomorphism, intraluminal budding in cervical cells during the pregnancy

Answer 15

Arias-Stella reaction

Question 16

Marked proliferation of cervical glands leads to the outward displacement of the os.

Answer 16

Eversion

Question 17

This hormone is produced by the CL, the decidua, and the placenta. It aids in remodelling of reproductive tract connective tissue to accomodate labor

Answer 17

Relaxin

Question 18

Benign ovarian lesions reflecting physiological follicle stimulation (hyperreaction luteinalis); linked to markedly elevated serum hCG levels (GTD, multifetal gestation)

Answer 18

Theca lutein cysts

Question 19

Violet discoloration of the vagina and cervix resulting from increased vascularity

Answer 19

Chadwick sign

Question 20

Thick, yellowish fluid expressed from the nipples by gentle massage

Answer 20

Colostrum

Question 21

Reddish, slightly depressed skin; in multiparas, glistening, silvery lines from previous striae

Answer 21

Striae gravidarum

Question 22

Rectus muscles separating in the midline when abdominal walls do not withstand the tension of the expanding pregnancy

Answer 22

Diastasis recti

Question 23

Develops in 90% of women, usually more accentuated in those with darker complexion; may be due to the melanocyte-stimulating effects of estrogen and progesterone

Answer 23

Hyperpigmentation

Question 24

Brown-black pigmentation in the midline of the anterior abdominal wall

Answer 24

Linea nigra

Question 25

Irregular brownish patches of varying sizes appearing on the face and neck

Answer 25

Chloasma

Question 26

Vascular changes - likely due to which hormone

Answer 26

Estrogen (hyperestrogenemia)

Question 27

Common on the face, neck, upper chest, and arms; minute, red skin papules with radicles branching out from a central lesion

Answer 27

Vascular spiders/ angiomas

Question 28

Increased cutaneous blood flow serves to dissipate excess heat generated by augmented metabolism

Answer 28

Palmary erythema

Question 29

Phases of hair cyclic activity

Answer 29

Periods of hair growth (anagen) Apoptosis-driven involution (catagen) Resting period (telogen)

Question 30

Excessive hair loss in the puerperium

Answer 30

Telogen effluvium

Question 31

Metabolic rate increase in 3rd trimester

Answer 31

20%

Question 32

Additional metabolic rate increase with twin gestation

Answer 32

10%

Question 33

Average weight gain during pregnancy

Answer 33

12.5 kg (27.5 lbs)

Question 34

Total extra water during pregnancy

Answer 34

6.5 L (water content from the fetus, placenta, and AF (~3.5L) + expanded maternal blood volume and from uterus and breast growth (3L)

Question 35

Carbohydrate metabolism characteristics during pregnancy

Answer 35

Mild fasting hypoglycemia, postprandial hyperglycemia, hyperinsulinemia

Question 36

Secreted by adipose tissue in non-pregnant humans; important for implantation, cell proliferation, and angiogenesis

Answer 36

Leptin

Question 37

Secreted by adipose tissue in non-pregnant humans; important for implantation, cell proliferation, and angiogenesis

Answer 37

Leptin

Question 38

Produced in maternal fat, not in the placenta - inversely correlated with adiposity - insulin sensitizer - reduced in patients with GDM

Answer 38

Adiponectin

Question 39

Secreted by the stomach and placenta in response to hunger

Answer 39

Ghrelin

Question 40

Elevated levels of this hormone, along with leptin, impair uterine contractility

Answer 40

VISFATIN

Question 41

This refers to the decrease in hemoglobin concentration due to plasma expansion during pregnancy

Answer 41

Physiologic anemia of pregnancy

Question 42

All clotting factors increase EXCEPT:

Answer 42

Factors XI and XIII

Question 43

Most common ECG change during pregnancy

Answer 43

Left axis deviation

Question 44

Refers to a syndrome caused by compression of the great vessels by the uterus in the supine position

Answer 44

Supine hypotensive syndrome

Question 45

Refractoriness to angiotensin II is probably due to this hormone

Answer 45

Progesterone

Question 46

Pulmonary volumes that DECREASE during pregnancy

Answer 46

Functional Residual Capacity (FRC) Total Lung Capacity (TLC)

Question 47

Pulmonary volumes that INCREASE during pregnancy

Answer 47

Inspiratory Capacity (IC) Tidal Volume (may be unchanged or decreased)

Question 48

Pulmonary volumes that DO NOT CHANGE during pregnancy

Answer 48

Inspiratory Capacity (IC) Tidal Volume (may be unchanged or decreased)

Question 49

Causes of elevated minute ventilation in pregnancy

Answer 49

•Enhanced respiratory drive due to PROGESTERONE •Low expiratory reserve volume •Compensated respiratory alkalosis

Question 50

GFR and renal blood flow changes during pregnancy

Answer 50

GFR increases by 25%, Renal blood flow increases by 80%

Question 51

Pathophysiology of increased risk of cholesterol gallstones in pregnancy

Answer 51

Progesterone inhibits CCK-mediated smooth muscles stimulation --> impairs GB contraction --> impaired emptying stasis --> cholesterol gallstones in pregnancy

Question 52

Constipation and elevated rectal vessels below the level of the enlarged uterus increases the risk for which GI tract abnormality?

Answer 52

Hemorrhoids

Question 53

Hormones that ensures lactation in early pregnancy

Answer 53

Prolactin

Question 54

This carrier protein increases due to ESTROGEN stimulation --> increases TOTAL T4 and T3 BUT do not affect free T4, T3

Answer 54

Thyroid-binding globulin

Question 55

The fetus relies heavily on maternal production of which thyroid hormone?

Answer 55

T4

Question 56

Pathophysiology of upper extremity weakness, numbness during pregnancy

Answer 56

Progressive lordosis + anterior neck flexion + shoulder girdle slumping --> traction on the ulnar and median nerves

Question 57

Brownish-red opacities in the posterior surface of the cornea; often observed in pregnancy

Answer 57

Krukenberg spindles